Can anyone here help me understand how disability works? I currently work full-time in the US and my understanding of what the disability process would be is more than a bit fuzzy.
As best I can figure, this is how I imagine it would work in my situation with my company's policies and benefits if I couldn't work anymore:
My doctor decides I medically need to be out on short-term dis
I contact my company's third-party provider to claim family & medical leave and short term disability
If they are satisfied that I am temporarily disabled, they pay me 100% of salary for up to 12 weeks, which is specified in my company's policy, and my medical benefits continue as before
If they don't....ummm, what happens then? Go back to work or be unemployed?
After the 12 weeks, if my doctor decides that I am still unable to work I would go on long-term disability
I notify my company's third-party provider again to claim long-term disability
They decide if my claim is valid and if so, pay 65% of salary (based on my extra insurance contributions) indefinitely
And if they don't....again, what happens then?
Either way, would I still be covered by my company medical insurance? Would I need to pay COBRA?
Would I then (also?) be eligible for SSD (social security disability) and begin applying for that?
Which takes precedence, the private LTD insurance or the SSD, and how do they affect each other? If one gets denied, what does that mean for the other one? Does one reduce the other if I get both? Or do you pick one or the other?
I'm at the point now where my husband and I are really starting to worry about these things, and having some understanding of this "massive flow chart" would put my mind at ease a little. I realize my company's policies and benefits may be different than everyone else's, but anything you could tell me about this would be a little more info than I have now.
Lots of good questions. None of which I can answer firmly.
I imagine you would have to pay Cobra, My insurance has tiers you have an option to sign up for ei. 300 a week, 350 a week etc.. (short term) Long term is a yes or no item. Have you been on FMLA or is that still an option? Not any help realy sorry. I will be seeing who can help more.
Jay, I still appreciate it!
I was on FMLA and short-term disability last year (2006) when my appendix burst, but I was hospitalized and I'm not sure how that may have made things different. Plus obviously, that wasn't an on-going disability. Except that I do think it was the triggering event for my RA...
Suzanne my profession was in payroll and HR so I will try my best to answer you. I have not been able to work since 2001 but am in the SSDI process so I can help some.
To file SSDI your Dr must state that you are unable to work for 12 months or more and you can file for it regardless of whether you have private disability or not. The SSDI process takes an average of 2 years and I highly recommend an attorney if you decide to file for it. If you have any more SSDI questions shoot me a pm. I passed 2 yrs last month and am awaiting a hearing before the judge.
To file for SSDI while on your Private STD/LTD totally depends on the contract your employer has with the providers. Your HR/payroll person should be able to answer questions regarding STD/LTD.
Some companies consider employees on STD/LTD full employees and they keep their health benefits and some companies don't.
If you don't trust discussing these issues with your HR/payroll person ask for a copy of your current benefits summary to take home as the one you rec'd upon employment may not be current and if you have a question about anything in it shoot me a pm and I will sure try to answer it.
Take care
Gee, I guess my husband and I can count our blessings....he filed for SSDI 4 months ago and was awarded last Thursday. We did use a lawyer -- guess that's why it went through the first time. He has 3 herniated discs and stenosis - can't stand more than a few minutes at a time. We are both gonna be in bad shape if my RA takes a turn for the worse....right now it is mild, knock on wood, and I am able to push his wheelchair when necessary.Thanks, Bonny. To clarify, to apply for SSDI, do you need to already not have worked for 12 months, or is it just that the doctor is saying you won't be able to work for at least 12 months? In other words, at what point do you apply for SSDI? I'm sorry yours is taking so long, but that is something I've heard quite frequently.
Unfortunately you are right that I am not comfortable talking with my HR people, but I do have the current benefits summary online as well as the open enrollment package they sent a few weeks ago. I will try to go through it again. I'm wondering if maybe I should consult an attorney just to navigate the earlier processes, but it is so expensive and more effort than I have energy for.
BTW, my company is known for firing people as soon as they apply for LTD, so I'm guessing they don't keep their medical benefits going unless the law requires them to.
Nancy, I have a couple of herniations each in the lumbar and cervical areas, and cervical stenosis. My standing is getting worse and worse, and that's part of the problem too. I'm glad you're able to help out your hubby, but if ever you have trouble, that's what electric scooters are made for.
If you want more detail, pm me. I don't want to bore everyone by going on and on.
edit to say, disability pays 50% and I get 50% from my employer so I get 100% of my pay instead of 65% I would get if I was totally disabled under my policy. You will need to take a look at yours to make sure how it works. If I were you I would take the policy to your personal insurance agent or someone not affiliated with your company so you know about all the fine print before applying.
Crispy, I'm glad you mentioned that. I had no idea they might do a part-time long-term disability. I'm not sure that would work with my job, or if my provider offers it, but it's good to know what questions to ask!
What I'm really hoping for, when I talk to my rheumy tomorrow night, is to go on STD for a few weeks or months while I rest, the Rituxan does its magic, and I go for aquatic physical therapy (which is extremely difficult to do while working). Then I am really hoping to get better (better than I am now) and get back to work. Not sure that this is realistic, but it's what I'm hoping.
I just went on partial short term disability (I am lucky as my company know offers partial so I don't have to choose not to work at all yet as I wasn't totally ready for that). In my company's policy, I had to use 14 days of sick or vacation pay after the doctor turned in my notice for disability. After which point, I get 90 days of 60% pay with full medical benefits. If my paycheck from the company (my disability pay comes from the insurance carrier) is less than my insurance premiums due, I have to pay them. When I went out for knee surgery two years ago, that ended up happening. Right now I am working Monday, Wednesdays, and Fridays so I will make plenty for the premiums.
Once my 90 days of short term are up, I go on to long term disability (which for me is still 60%) pay. If I am out all the way, I lose the company paid medical and I can choose COBRA. From what I understand from our HR person, the FMLA allows me to keep my medical benefits during my short term. FMLA does not have to be consecutive days but scattered like I am doing. It is for 6 months. However, I am not sure if that is how I am keeping medical during my short term.
SS is harder as stated above. It took my Mom two years to get it for lupus, fibromyalgia, and depression (she says have the Dr. list as many conditions as you have). She did get a lawyer after going through the first round. She says they back pay you after you win it and if you get a lawyer, they usually get 10% of that winning. She said she also made a point of how she didn't even have the energy to cook anymore for the family. You know Moms, she is getting me ready for the time I need SS.
Remember that you are protected by the disability act. If you fear your company may fire you. Make sure you document everything, including job performance evaluations. And talk to a lawyer if it looks scary.
Good luck as I know this is a hard to thing to think about. It took my husband and I over year to come to the decision that I need to work part time.
Alright, I geared my brain together enough to try to decipher all those plan documents, and here's what I learned (for the benefit of anyone else who's playing along):
My doctor decides I medically need to be out on short-term disOf course the big problem is if either the STD or LTD is denied. Or if I am fired before the LTD claim is approved...not sure exactly how that timeframe would work.
My provider does have programs for part-time work and rehab programs, so there are some other alternatives.
I can definitely see where the confusion comes from, Suzanne! Goodness, I think I need a nap now!Your Dr must document in your medical file that you cannot remain gainfully employed for at least the next 12 months in order to apply for SSDI.
Anyone that wins SSDI in 4 months is really blessed. I have RA/OA/PN and a firm doing the filing for me. The average award is 2 yrs which is at the ALJ hearing level and though I will get all of the backpay it is tough waiting so long.
Take care
Wow. I never knew it was so hard to get disability because it seems like everyone knows someone on it. I would hope that they would be able to sort the people who truly require the assistance from those who are actually capable of a full time job.
Bonny, you're right down the "street" from me.
My STD wouldn't officially start until I've been out for 3 work days (which is when you're supposed to contact the third party provider) so that would be the Wednesday after Thanksgiving. Does anyone know for sure if I'd have any protection after notifying my boss, or should I call my ex (who's an attorney, but this is not his specialty)?
As to filing for SSD you do not have to wait 12 months to apply. You can apply the day after you stop working. If you are approved you will not receive benefits for the first 5 months. The sooner you apply the sooner the process starts. I applied Sept 2003, got denied twice, got a lawyer and got approved at my adm hearing April 2006. Some people are fortunate to get it right away and others aren't so lucky.